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Liverpool, Australia

Levesque J.V.,University of New South Wales | Levesque J.V.,Ingham Institute for Applied Medical Research | Levesque J.V.,Ingham Institute | Maybery D.J.,Monash University
Supportive Care in Cancer | Year: 2014

Purpose: This study aims to determine the principal component structure of the Parental Cancer Questionnaire (PCQ) in a sample of adult children whose parents had cancer and to illustrate the validity and reliability of subscales. Method: The PCQ was administered to 311 adult children of parents with cancer along with the Posttraumatic Growth Inventory, Carer's Assessment of Difficulties Scale, Carer's Assessment of Satisfactions Scale, Reaction to Diagnosis of Cancer Questionnaire, and the Grief Diagnostic Instrument. Results: Exploratory Principal Components Analysis identified three dimensions of the parental cancer experience (explaining 51 % of the variance amongst scale items). The components were parental cancer benefits (e.g. 'I became closer to my sick parent during his/her cancer.'), emotional experiences (e.g. 'I was devastated by my parent's cancer.'), and caregiver strain (e.g. 'I feel/felt there was nobody to assist or support me in caring for my parent.'). Convergent and discriminant validity were demonstrated by meaningful correlations with other related measures (ranging from 0.14 to 0.68), and strong internal reliability was shown with Cronbach α between 0.87 and 0.91. Conclusions: The PCQ has a clear three-component structure and demonstrates good reliability. The measure has excellent face, content, convergent, and discriminant validity, indicating a structure suitable for use in future research. The measure appears to be a useful measure of the experience of parental cancer for adult children. © 2013 Springer-Verlag Berlin Heidelberg. Source

Eapen V.,University of New South Wales | Eapen V.,Ingham Institute | Robertson M.M.,University College London
Neuropsychiatric Disease and Treatment | Year: 2015

This study addressed several questions relating to the core features of Tourette syndrome (TS) including in particular coprolalia (involuntary utterance of obscene words) and copropraxia (involuntary and inappropriate rude gesturing). A cohort of 400 TS patients was investigated. We observed that coprolalia occurred in 39% of the full cohort of 400 patients and copropraxia occurred in 20% of the cohort. Those with coprolalia had significantly higher Yale Global Tic Severity Scale (YGTSS) and Diagnostic Confidence Index (DCI) total scores and a significantly higher proportion also experienced copropraxia and echolalia. A subgroup of 222 TS patients with full comorbidity data available were also compared based on whether they had pure-TS (motor and vocal tics only) or associated comorbidities and co-existent psychopathologies (TS-plus). Pure-TS and TS-plus groups were compared across a number of characteristics including TS severity, associated clinical features, and family history. In this subgroup, 13.5% had pure-TS, while the remainder had comorbidities and psychopathologies consistent with TS-plus. Thirty-nine percent of the TS-plus group displayed coprolalia, compared to (0%) of the pure-TS group and the difference in proportions was statistically significant. The only other significant difference found between the two groups was that pure-TS was associated with no family history of obsessive compulsive disorder which is an interesting finding that may suggest that additional genes or environmental factors may be at play when TS is associated with comorbidities. Finally, differences between individuals with simple versus complex vocal/motor tics were evaluated. Results indicated that individuals with complex motor/vocal tics were significantly more likely to report premonitory urges/sensations than individuals with simple tics and TS. The implications of these findings for the assessment and understanding of TS are discussed. © 2015 Eapen and Robertson. Source

Thakkar V.,University of Western Sydney | Thakkar V.,University of New South Wales | Thakkar V.,Ingham Institute | Lau E.M.T.,University of Sydney
Best Practice and Research: Clinical Rheumatology | Year: 2016

Over the past two decades, there have been several advances in the assessment and management of connective tissue disease-related pulmonary arterial hypertension (CTD-PAH) that improved outcomes of the treatment of this lethal disease, and this will be the focus of this study. Systemic sclerosis is the leading cause of CTD-PAH, followed by systemic lupus erythematosus, mixed connective tissue disease, idiopathic inflammatory myositis, rheumatoid arthritis, and Sjogren's syndrome. Clinical registries have been invaluable in informing about the burden of disease, risk and prognostic factors, and temporal trends with respect to treatment and outcome in CTD-PAH. The major advances have centered on improved disease classification and diagnostic criteria, screening and early diagnosis, the emergence of evidence-based therapies including combination goal-orientated treatment strategies, and the establishment of centers with expertise in PAH. © 2016. Source

Leung M.,University of New South Wales | Wong V.W.,Ingham Institute | Hudson M.,Macquarie University | Hudson M.,University of Sydney | Leung D.Y.,University of New South Wales
Circulation: Cardiovascular Imaging | Year: 2016

Background-Patients with type 2 diabetes mellitus are at risk of heart failure. Specific therapeutic interventions for diabetic heart disease are still elusive. We aimed to examine the impact of improved glycemic control on left ventricular (LV) function in these patients. Methods and Results-A total of 105 subjects with type 2 diabetes mellitus (aged 54±10 years) and poor glycemic control received optimization of treatment for blood glucose, blood pressure, and cholesterol to recommended targets for 12 months. LV systolic and diastolic function, measured by LV global longitudinal strain (GLS) and septal e′ velocities, were compared before and after optimization. At baseline, patients had impaired LV systolic (GLS-14.9±3.2%) and diastolic function (e′ 6.2±1.7 cm/s). After 12 months, glycated hemoglobin (HbA1c) decreased from 10.3±2.4% to 8.3±2.0%, which was associated with significant relative improvement in GLS of 21% and septal e′ of 24%. There was a progressively greater improvement in GLS as patients achieved a lower final HbA1c. Patients achieving an HbA1c of <7.0% had the largest improvement. The 15 patients whose HbA1c worsened experienced a decline in GLS. Patients who improved their HbA1c by ≥1.0% had a significantly higher relative improvement in e′ than those who did not (32% versus 8%; P=0.003). Baseline GLS, decrease in body mass index, and treatment with metformin were additional independent predictors of GLS improvement. Conclusions-Improvements in glycemic control over a 12-month period led to improvements in LV systolic and diastolic function. This may have long-term prognostic implications. © 2016 American Heart Association, Inc. Source

Stanley A.J.,University of New South Wales | Hasan I.,Ingham Institute | Crockett A.J.,University of South Australia | Crockett A.J.,University of Adelaide | And 2 more authors.
npj Primary Care Respiratory Medicine | Year: 2014

Background: Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. Aim: To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Methods: Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. Results: The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. Conclusions: The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives. © 2014 Primary Care Respiratory Society UK/Macmillan Publishers Limited. Source

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